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Spinal Discitis and Epidural Abscess

Published online by Cambridge University Press:  03 September 2024

Damjan Veljanoski
Affiliation:
University Hospitals Plymouth NHS Trust
Pragnesh Bhatt
Affiliation:
Aberdeen Royal Infirmary and University of Aberdeen

Summary

Spinal infections (SIs) are rare conditions affecting the intervertebral disc, vertebral body and/or adjacent spinal tissues. The lumbar region is most commonly involved, followed by the thoracic and cervical regions. Patients present with varied, non-specific clinical features leading to diagnostic and treatment delays. Clinicians need to have a low threshold to suspect SI. In this Element, two real-life cases of patients with SIs will be presented first. Core knowledge will be reviewed next, followed by diagnostic pitfalls and clinical pearls. Finally, the 'typical' clinical workflow for a patient with SI will be presented and the various treatment options will be explored.
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Online ISBN: 9781009409391
Publisher: Cambridge University Press
Print publication: 03 October 2024

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References

Eck, JC, Kim, CW, Currier, BL, Eismont, FJ. Infections of the spine. In Steven R. Garfin, Frank J. Eismont, Gordon R. Bell, Christopher M. Bono, Jeffrey S. Fischgrund The Spine. Philadelphia Elsevier; 2018. p. 1256.Google Scholar
Enthoven, WTM, Geuze, J, Scheele, J, et al. Prevalence and ‘red flags’ regarding specified causes of back pain in older adults presenting in general practice. Phys Ther. 1 March 2016;96(3):305–12.CrossRefGoogle ScholarPubMed
Jarvik, JG, Deyo, RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. October 2002;137(7):586–97.CrossRefGoogle ScholarPubMed
Premkumar, A, Godfrey, W, Gottschalk, MB, Boden, SD. Red flags for low back pain are not always really red: A prospective evaluation of the clinical utility of commonly used screening questions for low back pain. JBJS. 7 March 2018;100(5):368.CrossRefGoogle ScholarPubMed
Grammatico, L, Baron, S, Rusch, E, et al. Epidemiology of vertebral osteomyelitis (VO) in France: Analysis of hospital-discharge data 2002–2003. Epidemiol Infect. May 2008;136(5):653–60.CrossRefGoogle ScholarPubMed
Lener, S, Hartmann, S, Barbagallo, GMV, et al. Management of spinal infection: A review of the literature. Acta Neurochir (Wien). March 2018;160(3):487–96.CrossRefGoogle ScholarPubMed
Mylona, E, Samarkos, M, Kakalou, E, Fanourgiakis, P, Skoutelis, A. Pyogenic vertebral osteomyelitis: A systematic review of clinical characteristics. Semin Arthritis Rheum. 1 August 2009;39(1):1017.CrossRefGoogle ScholarPubMed
Stüer, C, Stoffel, M, Hecker, J, Ringel, F, Meyer, B. A staged treatment algorithm for spinal infections. J Neurol Surg Part Cent Eur Neurosurg. March 2013;74(2):8795.Google ScholarPubMed
Corrah, TW, Enoch, DA, Aliyu, SH, Lever, AM. Bacteraemia and subsequent vertebral osteomyelitis: A retrospective review of 125 patients. QJM Int J Med. 1 March 2011;104(3):201–7.CrossRefGoogle ScholarPubMed
Murray, MR, Schroeder, GD, Hsu, WK. Granulomatous vertebral osteomyelitis: An update. JAAOS – J Am Acad Orthop Surg. September 2015; 23(9):529.CrossRefGoogle ScholarPubMed
Wiley, AM, Trueta, J. The vascular anatomy of the spine and its relationship to pyogenic vertebral osteomyelitis. Bone Jt J. November 1959;41B(4): 796–809.Google Scholar
Cornett, CA, Vincent, SA, Crow, J, Hewlett, A. Bacterial spine infections in adults: Evaluation and management. JAAOS – J Am Acad Orthop Surg. January 2016;24(1):1118.CrossRefGoogle ScholarPubMed
Calderone, RR, Larsen, JM. Overview and classification of spinal infections. Orthop Clin North Am. January 1996;27(1):18.CrossRefGoogle ScholarPubMed
James, SLJ, Davies, AM. Imaging of infectious spinal disorders in children and adults. Eur J Radiol. 1 April 2006;58(1):2740.CrossRefGoogle ScholarPubMed
Silber, JS, Anderson, DG, Vaccaro, AR, Anderson, PA, McCormick, P. Management of postprocedural discitis. Spine J. 1 July 2002;2(4): 279–87.CrossRefGoogle ScholarPubMed
Bos, EME, Haumann, J, de Quelerij, M, et al. Haematoma and abscess after neuraxial anaesthesia: A review of 647 cases. Br J Anaesth. April 2018;120(4): 693704.CrossRefGoogle ScholarPubMed
Hong, SH, Choi, JY, Lee, JW, et al. MR imaging assessment of the spine: Infection or an imitation? Radiographics. 2009;29(2):599–612.Google ScholarPubMed
Tsantes, AG, Papadopoulos, DV, Vrioni, G, et al. Spinal infections: An update. Microorganisms. 27 March 2020;8(4):476.CrossRefGoogle ScholarPubMed
Veljanoski, D, Tonna, I, Barlas, R, et al. Spinal infections in the north-east of Scotland: A retrospective analysis. Ann R Coll Surg Engl [Internet]. 29 July 2022 [cited 6 September 2022]; https://publishing.rcseng.ac.uk/doi/10.1308/rcsann.2022.0062Google Scholar
Torrie, P, Leonidou, A, Harding, I, et al. Admission inflammatory markers and isolation of a causative organism in patients with spontaneous spinal infection. Ann R Coll Surg Engl. November 2013;95(8):604–8.CrossRefGoogle ScholarPubMed
Chenoweth, C, Bassin, B, Mack, M, et al. Vertebral osteomyelitis, discitis, and spinal epidural abscess in adults. Guidel Inpatient Clin Care Mich Sch Med. December 2018;Google Scholar
Sundaram, V, Doshi, A. Infections of the spine: A review of clinical and imaging findings. Appl Radiol. August 2016;45(8):1020.CrossRefGoogle Scholar
Salaffi, F, Ceccarelli, L, Carotti, M, et al. Differentiation between infectious spondylodiscitis versus inflammatory or degenerative spinal changes: How can magnetic resonance imaging help the clinician? Radiol Med (Torino). April 2021;126(6):843–59.CrossRefGoogle ScholarPubMed
Boudabbous, S, Paulin, EN, Delattre, BMA, Hamard, M, Vargas, MI. Spinal disorders mimicking infection. Insights Imaging. 4 December 2021; 12(1):176.CrossRefGoogle ScholarPubMed
Marschall, J, Bhavan, KP, Olsen, MA, et al. The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis. Clin Infect Dis. April 2011;52(7):867–72.Google Scholar
Greenberg, MS. Destructive lesions of the spine. In Mark S. Greenberg Handbook of Neurosurgery. Ninth New edition. New York: Thieme Medical; 2019. p. 1471–2.Google Scholar
Roversi, M, Mirra, G, Musolino, A, et al. Spondylodiscitis in children: A retrospective study and comparison with non-vertebral osteomyelitis. Front Pediatr [Internet]. 2021 [cited 11 September 2022];9. www.frontiersin.org/articles/10.3389/fped.2021.727031CrossRefGoogle ScholarPubMed
Chandrasenan, J, Klezl, Z, Bommireddy, R, Calthorpe, D. Spondylodiscitis in children. J Bone Joint Surg Br. August 2011;93-B(8):1122–5.Google ScholarPubMed
Dayer, R, Alzahrani, MM, Saran, N, et al. Spinal infections in children. Bone Jt J. April 2018;100-B(4):542–8.Google ScholarPubMed
Bartolo, DCC, Ebbs, SR, Cooper, MJ. Psoas abscess in Bristol: A 10-year review. Int J Colorectal Dis. 1 June 1987;2(2):72–6.CrossRefGoogle Scholar
Tabrizian, P, Nguyen, SQ, Greenstein, A, Rajhbeharrysingh, U, Divino, CM. Management and treatment of iliopsoas abscess. Arch Surg. 1 October 2009;144(10):946–9.CrossRefGoogle ScholarPubMed
Shields, D, Robinson, P, Crowley, TP. Iliopsoas abscess – A review and update on the literature. Int J Surg. 1 January 2012;10(9):466–9.CrossRefGoogle ScholarPubMed
Mynter, H. Acute psoitis. Buffalo Med Surg J. 1881;21:202–10.Google ScholarPubMed
Chern, CH, Hu, SC, Kao, WF, et al. Psoas abscess: Making an early diagnosis in the ED. Am J Emerg Med. 1 January 1997;15(1):83–8.CrossRefGoogle Scholar
Mallick, IH, Thoufeeq, MH, Rajendran, TP. Iliopsoas abscesses. Postgraduate Medical Journal. August 2004;80(946):459–62.Google Scholar
Yacoub, WN, Sohn, HJ, Chan, S, et al. Psoas abscess rarely requires surgical intervention. Am J Surg. 1 August 2008;196(2):223–7.CrossRefGoogle ScholarPubMed
Devlin, VJ, Steinmann, JC. Chapter 67 – Spinal infections. In Devlin, VJ, editor. Spine Secrets Plus (Second Edition) [Internet]. Saint Louis: Mosby; 2012 [cited 28 September 2023]. p. 466–72. www.sciencedirect.com/science/article/pii/B9780323069526000762Google Scholar
Heusner, AP. Nontuberculous spinal epidural infections. N Engl J Med. 1948 Dec 2;239(23):845–54.CrossRefGoogle ScholarPubMed
Ghobrial, GM, Beygi, S, Viereck, MJ, et al. Timing in the surgical evacuation of spinal epidural abscesses. Neurosurg Focus. 1 August 2014; 37(2):E1.CrossRefGoogle ScholarPubMed
Behmanesh, B, Gessler, F, Quick-Weller, J, et al. Early versus delayed surgery for spinal epidural abscess: Clinical outcome and health-related quality of life. J Korean Neurosurg Soc. November 2020;63(6): 757–66.CrossRefGoogle ScholarPubMed
Tuchman, A, Pham, M, Hsieh, PC. The indications and timing for operative management of spinal epidural abscess: Literature review and treatment algorithm. Neurosurg Focus. August 2014;37(2):E8.CrossRefGoogle ScholarPubMed
Guerado, E, Cerván, AM. Surgical treatment of spondylodiscitis: An update. International Orthopaedics. February 2012;36(2):413–20.Google Scholar
Falavigna, A, Santos de Moraes, OJ. Treatment of discitis and epidural abscess. In Winn. H.R Youmans and Winn Neurological Surgery. Philadelphia. Elsevier. Seventh edition. 2017. 2390–2397.Google Scholar
Fontes, RBV. Treatment of pyogenic spondylodiscitis. In Youmans and Winn Neurological Surgery [Internet]. [cited 29 September 2023]. pp. 25312536.e1. www.clinicalkey.com/#!/content/book/3-s2.0-B9780323661928003232Google Scholar
Berbari, EF, Kanj, SS, Kowalski, TJ, et al. 2015 infectious diseases society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adultsa. Clin Infect Dis. 15 September 2015;61(6):e2646.CrossRefGoogle Scholar

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Spinal Discitis and Epidural Abscess
  • Damjan Veljanoski, University Hospitals Plymouth NHS Trust, Pragnesh Bhatt, Aberdeen Royal Infirmary and University of Aberdeen
  • Online ISBN: 9781009409391
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Spinal Discitis and Epidural Abscess
  • Damjan Veljanoski, University Hospitals Plymouth NHS Trust, Pragnesh Bhatt, Aberdeen Royal Infirmary and University of Aberdeen
  • Online ISBN: 9781009409391
Available formats
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Spinal Discitis and Epidural Abscess
  • Damjan Veljanoski, University Hospitals Plymouth NHS Trust, Pragnesh Bhatt, Aberdeen Royal Infirmary and University of Aberdeen
  • Online ISBN: 9781009409391
Available formats
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